Figure 11.

Example of macroscopic and microscopic features of brain death. Brain from a 33-year-old man with a history of sepsis, extubated 5 days following brain-death declaration, with marked swelling and gray-brown discoloration (A); note relative preservation of architectural relationships on axial cut section, as well as focal petechiae at sites of partial reperfusion (arrows, B). Neurohistology of frontal cortex, with artifactual “fracturing” of devitalized tissue; note stellate crystalline change (arrows, C; 100×), and finely granular subpial mineralization (D; 400×). Temporal cortex with artifactual “fracturing” of devitalized tissue; this area must have had partial reperfusion to allow neutrophilic influx among hypereosinophilic (ischemic) neurons (E; 400×). Pons days following brain-death declaration, with “washed out picture” of devitalized tissue, and no cellular reaction; note red cell outlines visible in vascular lumen (F; 200×); ventral subpial region which must have had partial reperfusion to allow inflammatory cell influx (now “washed out,” arrows, G; 200×), and reperfusion hemorrhage (site of petechiae in B).